Standardized protocols improve quality of care for Neonatal Abstinence Syndrome

1. From 2012 to 2014, for infants with Neonatal Abstinence Syndrome (NAS), the length of pharmacological treatment (LOT) decreased from 16 days to 15 days and length of stay (LOS) decreased from 21 days to 19 days.

2. Patients with NAS on a standardized protocol were less likely to be discharged from the hospital on medication than those not on a standardized protocol.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Over the last 10 years, the incidence of NAS has increased 5-fold, concomitantly rising with an increased use of opiates during pregnancy. Caring for patients with NAS differs from hospital to hospital, and with that difference in care comes a difference in outcomes. This quality improvement study aimed to implement standards of care for NAS at 199 different U.S. hospitals in hopes of improved quality care and better outcomes. Results demonstrated significantly reduced LOT, LOS, and number of infants discharged on medications over the 2-year study period. This study was limited by the availability of prenatal maternal drug use, the possible presence of an unmeasured cofounder, and limited generalizability due to the enrollment of state collaboratives. These findings could encourage hospitals to standardize NAS care in order to participate in the shift towards improved outcomes called by the American Association of Pediatrics (AAP).

Click to read the study, published today in Pediatrics

Relevant Reading: Implementation of a neonatal abstinence syndrome weaning protocol: a multicenter cohort study.

In-Depth [prospective cohort]: Data in this study included serial cross-sectional audits in the Vermont Oxford Network NAS Internet Based Quality Improvement Collaborative (iNICQ), which included 199 participating medical centers and 3458 infants with NAS. Planned audits were performed between Feb 2013 to Aug 2014 and involved questions derived from AAP guidelines. The focuses of this quality improvement collaborative included a quality improvement kit, internet-based interactive webinars, a virtual video visit and facilitator’s guide, standardized data collection, and feedback on outcome measures. Standardization was successful: participating centers increased the mean number of their NAS standards from 3.7 to 5.1 out of 6 total measured policies. The percentage of patients discharged from the hospital on a medication taper significantly decreased during the 2-year study from 39.7% to 26.5% (p = 0.02). Similarly, the LOT decreased from a median of 16 days to 15 days (p = 0.02) and LOS decreased from 21 to 19 days (p = 0.002).

Image: PD

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